Monitoring fetal characteristics by radiotelemetric transmission

ABSTRACT

A fetal monitor is provided for gathering characteristic data such as fetal electrocardiogram, temperature and intra-uterine pressure so that fetal health may be determined during intra-operative and postoperative periods. The fetal monitor comprises a remote sensing unit, the remote sensing unit containing sensors which continually sample fetal temperature and electrocardiogram. A transceiver is housed in the remote sensing unit and outputs the sampled fetal temperature and electrocardiogram signals to an external antenna. A monitoring station is provided for monitoring the fetal temperature and electrocardiogram signals from the antenna. Additionally, a pressure transducer may be housed in the remote sensing unit for continually sampling intra-uterine pressure. This intra-uterine pressure signal in combination with the above signals are utilized to determine fetal health or the onset and progress of parturition.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application makes reference to the following U.S. Applications. Thefirst application is U.S. Application Ser. No. 08/081,133, entitled"Monitoring Uterine Contractions by Radiotelemetric Transmission", filedJun. 25, 1993. This application is hereby incorporated by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to measuring devices, and moreparticularly to a measuring device that measures characteristics such asfetal electrocardiogram, temperature and intra-uterine pressure todetermine fetal health during intra-operative and postoperative periods.

2. Description of the Prior Art

Improvements in obstetrical ultrasound have stimulated continuousimprovements in a doctor's ability to treat congenital anomalies. In thepast twenty years it has become possible to treat a fetus with acongenital anomaly in a progressively interventional fashion. Fetalcardiac arrhythmia's can be treated pharmacologically, see "Treatment ofFetal Arrhythmias," Wladimiroff & Stewart, Br. J. Hosp. Med. (1985).Fetal anemia can be corrected by intra-uterine transfusion of blood, see"Intrauterine Transfusion of Fetus in Hemolytic Disease," Liley, A. W.,Br. Med. J., 5365: 1107-1109 (1963). Additionally, some fetal conditionsare amenable to percutaneous catheter drainage, see "Catheter Shunts forFetal Hydronephrosis and Hydrocephalus," Manning, Harrison & Rodeck, N.Eng. J. Med., 315: 336-340 (1986). Finally, there are some highlyselected life-threatening fetal anomalies that can only be treated byhysterotomy and open surgical repair of the fetal defect. For example,bilateral urinary tract obstructions, congenital diaphragmatic hernia,and some types of fetal tumors have all been treated by open surgicalrepair. For further information on fetal surgical procedures, see "EarlyExperience with Open Fetal Surgery For Congenital Hydromephrosis,"Crombleholme, Harrison & Langer, J. Pediatr. Surg., 23: 1114-1121(1988); "Correction of Congenital Diaphragmatic Hernia In-Utero. V.Initial Clinical Experience," Harrison et al., J. Pediatr. Surg.,25:47-57 (1990); "Successful Repair In-Utero of a Fetal DiaphragmaticHernia After Removal of Herniated Viscera from the Left Thorax,"Harrison et al., N. Eng. J. Med., 322:1582-1584 (1990); "Fetal Hydropsand Death from Sacrococcygeal Teratoma: Rational for Fetal Surgery,"Langer, Harrison & Schmidt, Am. J. Obstet. Gynecol., 160:1145-1150(1989); and "Antenatal intervention for Congenital Cystic AdenomatoidMalformation," Harrison, Adzick & Jennings, Lancet, 336:965-967 (1990).

As may be seen from the above articles, the need for an accurate devicefor monitoring fetal health is vital for increasing the success rate ofthe above mentioned surgical procedures. The monitoring of the fetus iscritical to fetal health care management and is also an aid in themonitoring of the onset of parturition. Thus, there are two criticalperiods for monitoring a fetus, 1) during intraoperative andpostoperative periods as well as 2) during the onset of parturition.

The current techniques for monitoring fetal health include themonitoring of the fetal electrocardiogram during intraoperative periodsor the use of ultrasound for postoperative periods. In both situations,there are significant drawbacks to these techniques.

During the intraoperative period, pulse oximetry, percutaneously placedelectrical leads, and sterile intraoperative ultrasound are utilized fordetermining fetal cardiac function. These devices are generally designedfor an adult and thus the sensitivity of the device is incapable ofdistinguishing the electrocardiogram signal of the fetus from that ofthe mother. Another problem with this type of device is the inability tosecure the electrocardiogram leads, even with sutures. Additionally,these devices were designed to operate in a dry environment while theenvironment of the fetus is a fluid based environment. Thus, there is aproblem with the electrical leads shorting and potentially burning orelectrically shocking the fetus. In order to avoid this possibility,current techniques require the removal of the leads when the fetus isreturned to the uterus. Thus, these techniques do not allow forcontinuous monitoring when the fetus is returned to the uterus and thehysterotomy is closed, a critical period of time when the umbilical cordmay be kinked or the fetus may be compromised by poor positioning.Finally, fetal electrocardiography, pulse oximetry, and intra-operativeultrasound are cumbersome and the electrocardiography and pulse oximetryequipment have been unreliable in the past.

During the intra-operative period, the monitoring of fetal temperatureis very important in the management of the fetus and the prevention ofintraoperative hypothermia. Currently there are no devices which provideboth fetal electrocardiogram and temperature signals.

During the postoperative period, the fetus may be monitored byelectromagnetic or acoustical signals and a doppler effect thereon. Forexample, U.S. Pat. No. 3,606,879 (Estes) discloses an ultrasonicapparatus which is used for monitoring fetal heartbeat by detecting thechange in frequency, due to a doppler effect, of an ultrasonic wavewhich passes through the fetus. Additionally, uterine contractions andcervical dilations are measured by the change in transit times of eachpulse of ultrasonic energy. This doppler signal is intermittent andunreliable because of fetal movement and positioning, especially in thesituation of fetal distress. The data from fetal doppler can bedifficult to interpret. For example, a signal dropping in magnitudecould mean either that the fetus has lost cardiac function or that thefetus has changed position. The use of real time ultrasound may only beperformed intermittently, i.e., is limited by the availability ofoperator time to only once or twice per day. Other techniques such asfetal electrocardiogram (ECG) recordings across the maternal abdomen andfetal phonocardiography are ineffective with respect to fetus' becauseof the small signal to noise ratio. The use of fetal scalp ECG is notpossible since the fetus is within the uterus with intact amnioticmembranes.

As mentioned earlier, the second period for measuring fetalcharacteristics is during the onset of premature labor or parturition,child birth.

Each year in the U.S., 5% of all infants are born prematurely at anenormous cost to the health care system. Premature births account for85% of neonatal deaths. About 10% of pregnant women in the U.S. are atrisk or premature labor. Accurate detection or prediction of theoccurrence of premature labor would allow the patient to beappropriately treated to suppress labor, thereby improving the chancesthat delivery will occur closer to term. The closer the delivery is toterm, the lower the mortality rate and the lower the cost post-deliveryneonatal care.

Several methods have been employed or proposed for detection orprediction of premature labor. These include both natural andinstrument-based means.

Symptomatic self-monitoring is a natural means whereby the mother iseducated in the symptoms of uterine contractions or cervical dilatationand receives regular counseling from a nurse. This approach has theadvantage that it is non-invasive and inexpensive, since it can be doneat home. However, it requires significant discipline, is time consumingfor the patient, and lacks uniform accuracy. Mammary stimulation,cervical distensibility, and fetal breathing movements encompass othernatural means. However, these methods require that the patient visit acare provider. They are therefore expensive and inconvenient.

Intrauterine pressure (IUP) measurement devices are considered to be themost accurate means available for measuring frequency of occurrence,duration, and intensity of uterine contractions. This technique hasfrequently been used to validate the accuracy of other methods ofmonitoring uterine activity. In this method a transvaginal catheter isinserted into the uterus. Open lumen fluid-filled catheters may be used,but require regular flushing to keep the lumen free of cellular debris.Catheters have been constructed with a balloon tip to eliminate the needfor regular flushing. Microballoon-tipped catheters provide pooraccuracy. Larger balloons provide better accuracy but their presenceleads to irritation and artifactual stimulation to both the uterus andfetus. In addition, their use is restricted to bed-ridden patients andthere is a risk of infection. Catheters that employ a solid statepressure transducer at the tip or fiber optic technology have also beenused. Use of these techniques is generally limited to bed-riddenpatients due to the risk of infection. An implantable pressuretelemetrydevice has also been used (Smyth, 1960) for monitoring intrauterinepressure. This device has been introduced into the uterine cavityexternal to the membranes to measure IUP following induction of labor.The authors suggest its use to "extending obstetric research andtreatment control." No reference is made to using this device as a toolfor prediction or detection or premature labor.

With the exception of symptomatic self-monitoring, use of the abovemethods has been restricted to a care providers office. However,successful treatment of preterm labor depends on early diagnosis (Iam,et. al., 1990) and these methods do not provide the timely informationneeded to effect prompt intervention and arrest labor. Methods suitablefor monitoring patients as they go about their daily activities presenta significant advantage in early diagnosis of preterm labor.

The guard-ring tocodynamometer provides a non-invasive means formonitoring uterine activity and represents the current state-of-the-artfor detecting premature labor in ambulatory patients. This device isplaced on the maternal abdomen and held in place by an elastic belt. Itemploys a "guard-ring" to flatten the abdomen within an area over whichpressure applied to a sensing diaphragm by the abdominal tissues issensed. Pressure measurements taken at this flattened area arerepresentative of intrauterine pressures. Some commercially availabletocodynamometers are capable of transmitting data to a clinic or doctorsoffice via telephone lines. Studies of the effectiveness of thesedevices have demonstrated variable results.

In an attempt to provide doctors with accurate information on thecondition of their patient during labor, many devices have been designedto detect both the onset of labor and the condition of the mother duringthe birthing process. The determination of the onset of labor is evenmore important when fetal surgery has been performed since preterm laboris a substantial problem associated with fetal surgery.

An example of one method for detection of parturition is the use oftemperature sensors to detect temperature changes in a mother. U.S. Pat.No. 4,651,137 (Zartman) discloses an intravaginal parturition alarm andmethod for its use. The device comprises an anchor, a temperature sensoraffixed to the anchor, and an alarm. During the onset of parturition,the anchor is displaced from an anterior portion of the female's vaginaand is expulsed to a posterior portion of the vagina. The temperaturesensor detects the change in temperature between the two vaginal regionsand activates the alarm. As is obvious, this method is highly invidious.

Aside from the use of the temperature change upon expulsion of an objectfrom the reproductive tract as an indicator of parturition, others haveattempted without success to show a reliable relationship betweentemperature phenomena and the onset of parturition and related events.Research reports may be summarized as describing a body temperatureincrease during the latter part of pregnancy, with a substantial dropduring the last few days to a few hours before parturition. However, fora number of reasons, the efforts of workers in the field to develop areliable relationship between temperature phenomena and the onset ofparturition have failed.

In fact the prior art would actually lead one away from the use oftemperature measurements as a reliable tool in the forecasting andidentification of occurrences related to parturition. Researchers in thefield generally reported failures in their attempts to use suchmeasurements in forecasting and determining occurrences related toparturition, thus dissuading other researchers from further study.Additionally, with only one exception, no current textbooks onreproductive physiology have been found that comment on any temperaturephenomenon related to parturition.

Detection of parturition in animals has been accomplished in variousways. For example, U.S. Pat. No. 4,707,685 (Carrier et al.) discloses asystem for detection of parturition which in effect is a continuitycircuit. When a cow enters parturition, a thin wire, disposed about theanimals vulva, is broken and thus continuity in an electric circuit isterminated. This lack of continuity sets off an alarm. U.S. Pat. No.4,936,316 (Jewett) discloses the monitoring of the swelling of ananimals vulva.

While significant efforts are made to monitor the mother, the otherparticipant in the berthing process, i.e., the fetus, is generallyignored as a source for information. One vital sign which is measured isthe fetal heartbeat. Physicians generally monitor the fetal heartbeat byusing a stethoscope to determine the fetal condition. This method offetal heartbeat monitoring is severely limited due to the shortcomingsin the ability of an individual to instantaneously analyze theinformation transmitted to him and to detect suitable characteristics ofthe fetal heartbeat pattern.

The importance of continuous fetal heart rate monitoring and theshortcomings of evaluation by stethoscope are discussed in "AnIntroduction to Fetal Heartrate Monitoring" by Edward H. Hon M.D.,published by the Postgraduate Division, University of SouthernCalifornia School of Medicine. This publication also discusses problemsassociated with the monitoring of fetal heart rate caused byinterference associated with uterine contractions during labor.

There has been an emergence of fetal monitoring devices which areutilized to monitor the status of the fetus during parturition. Forexample, U.S. Pat. No. 4,537,197 (Hulka) discloses a fetal oxygenmonitor which is attached to the fetus' scalp after the onset ofparturition, i.e, after the fetus' head is accessible through thevagina. The fetal monitor comprises a fetal scalp cap; a three channelcatheter; two fiber optic bundles connected to the cap, one fortransmitting light and the other for receiving light; and a oxygen levelanalyzer attached to the distal ends of the fiber optic bundles.

U.S. Pat. No. 3,989,034 (Hojaiban) discloses an apparatus fordetermining the heart rate of a fetus during labor. The device comprisesa means for receiving a measured fetal heart rate signal; a means forreceiving a uterus pressure signal; and a means for determining anactual fetal heart rate based upon the uterine pressure and the measuredfetal heart rate.

U.S. Pat. No. 4,951,680 (Kirk et al.) discloses an apparatus formonitoring a fetus during labor. The apparatus comprises a scalpelectrode for repeatedly deriving signals representative of the P-Rinterval of the fetal heart and the period of the fetal heartbeat; and amicroprocessor for determining fetal health based upon the change in theabove two signals.

None of these devices provide information on both fetalelectrocardiogram and fetal temperature. Fetal temperature is anessential criteria to measure for determining fetal distress syndrome,which may occur before or during parturition. When fetal distresssyndrome occurs, the fetus' temperature begins to climb dramatically,and the mother's temperature similarly undergoes a marked temperatureincrease. It is important to administer suitable treatment to remedy theproblem as soon as possible in order to reduce the risk of fetalmortality or injury. For further information, please see: Weisz, "TheTemperature Phenomenon Before Parturition and Its Clinical Importance,"J.A.V.M.A. 102:123 (1943).

The automatic administration of drugs based upon medical characteristicsof the patient are utilized in areas such as high blood pressuretreatment, blood oxygen concentration problems, and the treatment ofdiabetes. For example, U.S. Pat. No. 4,003,379 (Ellinwood) discloses amedication dispenser which is inserted into a patient's body and willdispense upon particular conditions being present. The dispensercomprises at least one sensor, control circuitry, a power source, adispensing means, and medication storage means. Sensors and logiccontrol circuitry are provided within the dispenser for measuring theexistence or absence of a particular condition such as high bloodpressure. The sensors may include 1) blood pressure detecting devices;2) electrical activity from the carotid sinus or aortic body; 3)possible electrical activity from the sympathetic outflow; and 4)electrocardiogram.

U.S. Pat. No. 4,543,955 (Schroeppel) discloses a medical implant whichincludes a sensor assembly disposed remotely from the implant; signalconverting circuitry for converting the signals from the sensor to acoded signal, a transmitting means for transmitting the coded signal,and an activation device for receiving the coded signal and actuatingthe activation device based upon the coded signal. The parameters sensedby this system are body temperature, blood oxygen concentrations orblood potassium concentrations.

U.S. Pat. No. 4,596,575 (Rosenberg et al.) discloses an insulindispenser. The device comprises an implant having a transducer, anelectronic control unit, a piezoelectric pump and an insulin reservoir.In operation, an external controller provides an actuation signal to thetransducer which in turn sends an actuation signal to the electroniccontrol unit. The control unit actuates the piezoelectric pump which inturn forces insulin to be dispensed from the reservoir.

While the prior art has appreciated the importance of suitablyadministering treatment to the mother and fetus upon the occurrence offetal stress syndrome, the prior art has failed to adequately provide ameans for detecting the onset of fetal stress syndrome and automaticallyadministering the required treatment.

Although current technology is available for comparing measurementsexpressed in quantitative form with quantitative tolerance limits andsignaling when those limits are exceeded and activating a device for theadministration of medication based upon this information, the evaluationof the fetal condition has, until now, often been a qualitative onebeyond the capabilities of the known state of the art identified above.Additionally, the prior art does not provide any teachings forcontinuously monitoring a fetus before the onset of parturition. Thismonitoring would be vitally important in cases where fetal surgery hasbeen performed.

SUMMARY OF THE INVENTION

It is therefore an object of the present invention to provide a fetalmonitor which will provide accurate information on the fetal healthduring intra-operative and postoperative periods.

It is a further object to provide a fetal monitor which is directlyattached to a fetus during fetal surgery.

It is yet another object to provide a fetal monitor which eliminates thepossibility of electrical shock and short circuits.

It is yet another object to provide a method for implanting theelectrical leads of the fetal monitor to accomplish the goal ofeliminating short circuits.

It is yet another object to provide a means for the accurate detectionof fetal temperature and electrocardiogram as well as maternalintra-uterine pressure.

In a second embodiment, it is an object to provide a fetal monitor foraccurately determining the onset of parturition.

It is a further object to provide a means for the accurate detection offetal temperature and electrocardiogram as well as maternalintra-uterine pressure, electromyogram and temperature of the uterus.

In a third embodiment, it is an object to provide a fetal monitor whichmay be used to collect data over conventional communications lines.

In all of the above embodiments, it is an object to provide an antennawhich provides invidious monitoring of the fetus during intra-operativeand postoperative periods as well as during the onset of parturition.

Finally, it is an object of the invention to provide a fetal monitorwhich may automatically dispense medication upon the existence ofparticular medical conditions.

According to one broad aspect of the present invention, there isprovided a fetal monitor comprising a means for continually sampling thetemperature of the fetus and for outputting a sampled temperaturesignal; a means for continually sampling the electrocardiogram of thefetus and for outputting a sampled electrocardiogram signal; and meansfor receiving said fetal temperature and electrocardiogram signals andfor determining the fetal health based upon the sampled temperature andelectrocardiogram signals.

According to another broad aspect of the invention, there is provided afetal monitor further comprising a uterine monitor. The uterine monitorcomprises a means for continually sampling the temperature of a motherand for outputting a sampled maternal temperature signal; a means forcontinually sampling the electromyogram of a mother's uterus and foroutputting a sampled maternal electromyogram signal; and means forreceiving said maternal temperature and electromyogram signals and fordetermining the existence of fetal conditions based upon said sampledmaternal temperature, maternal electromyogram, fetal temperature, andfetal electrocardiogram. Additionally, a means for continually samplingintra-uterine pressure and for outputting a sampled intra-uterinepressure signal may be provided. This intra-uterine pressure signal incombination with the above signals are utilized to determine the onsetand progress of parturition.

Other objects and features of the present invention will be apparentfrom the following detailed description of the preferred embodiment.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be further described in conjunction with theaccompanying drawings, in which:

FIG. 1 is a cross sectional view of a fetus in a uterus having anattached fetal monitoring and medication delivery system constructed inaccordance with a preferred embodiment of the invention;

FIG. 2 is a block diagram of the components of the fetal monitor andmedication delivery system of FIG. 1;

FIG. 3A is side elevational view of an electrocardiogram lead utilizedin conjunction with the fetal monitor of FIG. 1;

FIG. 3B is a side elevational view of the electrocardiogram lead of FIG.3A as installed by the preferred method of the invention;

FIG. 4A is a plan view of an alternate embodiment of a ring antennautilized in conjunction with the fetal monitor of FIG. 1;

FIG. 4B is a block diagram of an alternate communications methodutilized in conjunction with the fetal monitor of FIG. 1;

FIG. 4C shows a small contact loop antenna.

FIG. 5 is an alternate embodiment of the fetal monitor of FIG. 1;

FIG. 6A is a plot of maternal electrocardiogram versus time;

FIG. 6B is a plot of fetal electrocardiogram versus time;

FIG. 7 is a plot of fetal heart rate versus time;

FIG. 8 is a plot of intrauterine pressure versus time;

FIG. 9 is a plot of uterine contractility index versus time; and

FIGS. 10A, 10B, 10C and 10D are plots of maternal intra-uterine pressureand electromyogram versus time for severe, moderate, mild and no labor,respectively.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

With reference to the figures, wherein like reference charactersindicate like elements throughout the several views and, in particular,with reference to FIG. 1, a fetus 10 is disposed within the uterus 12 ofa mother 14. The uterus 12 is defined by a uterine wall 16 which islocated within the abdomen 18 of the mother 14. A fetal monitoringsystem, generally denoted 20, is provided to monitor the status of fetus10 during an intra-operative or postoperative period. The fetalmonitoring system 20 comprises an implantable remote sensing unit 22, amedication dispenser 24, an antenna 26, and a monitor 28.

Remote Sensing Unit

The remote sensing unit 22 is a remote sensing device which detectsfetal temperature and electrocardiogram. The remote sensing unit 22 mayalso detect intra-uterine pressure by a pressure transducer 30. Theremote sensing unit 22 is secured to the fetus 10 by at least oneelectrocardiogram lead 32. This lead is surgically inserted under theskin of the fetus 10 and will be discussed in detail below.

Referring to FIG. 2, a block diagram of the major components of remotesensing unit 22 are illustrated. As may be seen, circuitry for anelectrocardiogram (ECG) 34, a temperature (Temp) sensor 36 and anintra-uterine (IUP) 38 sensor are provided within remote sensing unit22. Information is transmitted to and from sensors 34, 36 and 38 via aninput/output (I/O) bus 40. I/O bus 40 also provides communicationbetween a transceiver 42 and sensors 34, 36 and 38. Power is supplied bya conventional power source 44 such as a silver oxide battery or anyother power source known in the art. An electronic control unit (ECU) 46is provided for controlling the power supply to sensors 34, 36 and 38 aswell as communication through I/O bus 40 and transceiver 42. Each of thecomponents of the remote sensing unit 22 will be described in detailbelow.

The electrocardiogram sensor 34 includes at least one electrocardiogramlead 32 which is affixed at a proximal end to a conventional signalprocessing circuit and at the distal end to the fetus 10. In thepreferred embodiment, there are two electrocardiogram leads 32, thefirst affixed to the posterior and the second to the anterior chestcavity of fetus 10. Referring to FIG. 3A, an electrocardiogram lead 32is illustrated. The electrocardiogram lead 32 is formed from an innerconductive material 48 having a distal tip portion 49 and an outerinsulative sheathing 50 which surrounds conductive material 48. Thedistal tip portion 49 of conductive material 48 is exposed to allow foran electrocardiogram signal to be transmitted along lead 32.

In conventional electrocardiogram leads, this distal tip portion 49 isleft exposed to the environment. Having an exposed tip portion 49creates significant problems when lead 32 is used in fetal monitoring.This exposed tip portion 49 may short-circuit the electrical circuitattached to the proximal end of lead 32 since lead 32 may be exposed toamniotic fluids which are maintained within the uterus 12.

This invention contemplates a method for surgically installing lead 32to prevent the possibility of a short circuit or electrical shock and isdescribed with reference to FIGS. 3A and 3B. As may be seen in FIG. 3A,a suture or other thin filament 52 is attached to the distal end of lead32 just before the exposed tip portion 49. Affixed to the other end ofsuture 52 is a needle 54. Next, an incision or I₁ is made in theposterior abdominal wall of fetus 10. Incision I₁ is wide enough toallow needle 54, suture 52 and the entire lead 32 to enter fetus 10.Then, needle 54 is positioned so as to thread lead 32 under the skin tothe anterior abdominal wall of fetus 10. A second incision or needlehole I₂ is made to allow needle 54 to be removed from fetus 10. IncisionI₂ is only wide enough to allow needle 54 and suture 52 to exit fetus10.

As may be seen in FIG. 3B, the conductive tip 48 is prevented fromexiting incision I₂ because its diameter exceeds that of incision I₂.Finally, incision I₂ may be sealed by suture 52 in a conventionalfashion. Thus, the entire lead 32 is maintained subcutaneously and isprevented from coming into contact with the amniotic fluid. This methodof subcutaneously implanting the lead 32 reduces the risk of ashort-circuit as well as that of electrical shock. While in a preferredembodiment the incision I₁ and I₂ are made in the respective posteriorand anterior abdominal walls, it is within the contemplation of thismethod to provide any entry and exit point for needle 54.

In a similar fashion, the above process is repeated for positioning andsecuring each lead 32 to fetus 10. After all leads are secured, remotesensing unit 22 is attached to the proximal ends of each respective lead32 and thus remote sensing unit 22 is firmly secured to the outer layerof skin of the fetus 10 by leads 32 or conventional sutures and suturetabs. Electrocardiogram data is gathered in a conventional fashion andmay be in either analog or digital form.

The temperature sensor 36 and associated signal processing circuit arean integral part of remote sensing unit 22. The sensor 36 is maintainedin contact with the outer layer of skin of fetus 10 by remote sensingunit 22 and associated leads 32. Temperature information is gathered ina conventional fashion and may be in either analog or digital form. Inan alternative embodiment, the above described temperature sensor 36will utilize a sensor which is disposed remotely from remote sensingunit 22. The prior art has failed to provide accurate temperaturemeasurements of fetus 10 during the intra-operative or postoperativeperiods.

The importance of intra-operative monitoring of fetal temperature wasdemonstrated during human fetal surgery operations which were conductedin conjunction with testing remote sensing unit 22. The rate at whichfetal temperature fell after fetus 10 was exposed to ambient air wasalarmingly quick. In less than 10 minutes, the fetal temperature droppedto dangerously low levels and was accompanied with a slowing in fetalheart rate. Thus, the quick and accurate monitoring of fetal temperatureis essential in detecting and preventing the onset of fetal hypothermia.

Additionally, the monitoring of fetal temperature during thepostoperative period is important in determining the onset of fetaldistress as well as the onset of parturition.

The pressure sensor 38 comprises a pressure transducer 30 and anelectronic circuit for signal processing, both of which are locatedwithin remote sensing unit 22. Additionally, a pressure transmissioncatheter 56 is disposed externally to remote sensing unit 22 and isconnected thereto for providing fluid communication between transducer30 and uterus 12. It should be appreciated that a solid state pressuresensor such as that used in pressure sensing pacemakers which measureincremental changes in pressure with respect to time, i.e., dp/dt, aswell as instantaneous pressure may be utilized in place of the sensor38, described above. This will eliminate the need for the pressuretransmission catheter 56 and thus reduce the problem of sterilizing theequipment. Additionally, it should be appreciated that a dual lumencatheter, such as that produced by Data Sciences of Minnesota, whichutilizes pressure transducer 30 and a gel, may be employed. Thisstructure has the advantage of maintaining accurate measurements withoutrequiring periodic flushing. Finally, fiber optic, capacitance,semiconductor strain gage, or any other type of pressure measuringdevice may be employed in sensing unit 22 in place of pressuretransducer 30.

An I/O Bus 40 is provided for allowing for interoperability betweensensors 34, 36 and 38 and transceiver 42. In a preferred embodiment, I/Obus 40 will be a simple one way communications line having buffers fordata storage. It should be appreciated that a more complex I/O bus maybe used in conjunction with a complex ECU 46 for providing additionalfeatures such as duplex communication, multiplexing or encoding. In apreferred embodiment, the I/O bus will have a communications line 58 forallowing information from sensors 34, 36 and 38 as well as controlinformation from ECU 46 to be relayed to medication dispenser 24.Communications line 58 may be a standard copper wire or fiber opticcable, it should be appreciated that communication between remotesensing unit 22 and medication dispenser 24 may be accomplished byradiotelemetry signal 60 between respective transceivers 42 and 64. Thisradiotelemetry signal is indicated in FIG. 2 as dashed line 60.

As mentioned above, remote sensing unit 22 contains a transceiver 42.Transceiver 42 is a combination of a radio transmitter and receiverwhich is maintained in a common housing and employs common circuitcomponents for both transmitting and receiving radio signals. In apreferred embodiment, the bandwidths of the radio signals are withinthat of traditional radio-telemetry devices. As mentioned above, thetransceiver 42 receives sensor data from the I/O bus 40 and then in turntransmits this sensor data to either an external antenna 26 or to amedication dispenser 24. It should be appreciated that any frequencyband may be employed for the transceiver so long as each band is uniqueto each particular transceiver 42. This is vitally important since theremay be more than one patient being monitored at any one time.Additionally, in an alternative embodiment, the frequency band used tocommunicate with the medication dispenser 24 will be different from thatof the antenna 26. As may be seen, communication between remote sensingunit 22 and medication dispenser 24 may be conducted via a radiotransmission channel indicated by dashed line 60 or by a moreconventional communications line 58.

Power is provided to the above components by a conventional power source44. It should be appreciated that since the normal term of a mother 14is approximately nine months, the power source 44 should be able toprovide continuous power to the above systems for that time period.Currently, silver oxide batteries are utilized which provide power forat least four months. Power distribution may be controlled by the ECU 46so that sensors 34, 36 and 38 may be selectively actuated when requiredand thus conserving the power supply from source 44.

The ECU 46 may be a conventional microcontroller which controls thecommunication along I/O bus 40 and power distribution as describedabove. For example, a known controller such as that described in Med.Progr. Technol. 9,17-25 (1982) may be utilized. Additionally, themicrocontroller may be modified by preprogramming it to automaticallyrespond to particular characteristics which are detected by sensors 34,36 and 38. In this case, the microcontroller may activate medicationdispenser 24 to allow for treatment to be automatically delivered.

All external components of the remote sensing unit 22 will be coatedwith a thin layer of silicon or encased in a biocompatible case to allowfor biocompatibility between the unit and fetus 10. This reduces thepossibility of infection or rejection of remote sensing unit 22 by fetus10.

Medication Dispenser

Turning now to the medication dispenser 24, as illustrated in FIG. 2,the major components of the medication dispenser 24 may be seen. Themedication dispenser 24 comprises an electronic control unit (ECU) 62, atransceiver 64, an I/O bus 66, a power supply 68, a pump 70, and amedication reservoir 72. Elements 62, 64, 66, and 68 correspond toelements 46, 42, 40, and 44 respectively and function similarly.Therefore, only the differences in these elements will be discussedbelow.

As mentioned above the ECU 62 is similar to that of ECU 46. It should beappreciated that either ECU 46 or 62 is capable of automaticallyresponding to particular characteristics which are detected by sensors34, 36 and 38. Thus, if one ECU is provided with this feature, the othermay have this feature deactivated. Alternatively, a comparator circuitmay be provided to determine if both ECUs 46 and 62 agree on theresponse to the particular condition. In that case, medication dispenser24 will only be activated if both ECUs 46 and 62 agree. Otherwise, anerror signal will be sent to monitor 28 via antenna 26. Another majordifference between ECUs is that ECU 62 will have to determine whichreservoir 72 to physically connect to pump 70. This may be accomplishedvia conduits and electromagnetically controlled valves or any othervalve means known in the art.

Pump 70 is preferably a piezoelectrically driven micro-pump generallysimilar to that described by Rosenberg et al. in U.S. Pat. No.4,596,575. The major difference between the pump of this invention andthat of Rosenberg is the location of the pump. Rosenberg contemplatesthe pumping of insulin into an adult patient. As is obvious, there aresignificant differences between and adult patient and fetus 10. Onemajor consequence of the difference between patients is the need foraccurate measurements of dispensed medication. Therefore, thesensitivity of pump 70 must be greater than that of Rosenberg. In thepreferred embodiment, the pump 70 will only be required to dispenseliquid medication. In an alternate embodiment, pump 70 may be modifiedto allow for dispensing of sold or powdered medications as well asliquids.

Finally, at least one reservoir 72 is provided for maintaining themedications. In a preferred embodiment, each reservoir 72 comprises acollapsible bag which is maintained within a rigid housing of medicationdispenser 24.

As mentioned earlier, data from sensors 34, 36 and 38 are provided tomedication dispenser 24 by remote sensing unit 22 via either acommunications line 58 or a radio transmission channel 60. In analternative embodiment, medication dispenser 24 will be provided withindependent data sensors. All external components of medicationdispenser 24 will be coated with a thin layer of silicon to allow forbiocompatibility between dispenser 24 and fetus 10. This reduces thepossibility of infection or rejection of medication dispenser 24 byfetus 10.

It should be appreciated that no known references have suggested thedirect medical treatment of a fetus 10 by an automatic medicationdispenser 24. The risk associated with such a device would generallyexceed its practical use. But with the onset of fetal surgery, thebenefit of such a device may far exceed the risk to fetus 10. This isdue to the generally poor health of fetus 10 combined with the potentialtrauma caused by fetal surgery. Thus, the ability to monitor the healthof fetus 10 in combination with the automatic delivery of medicationdirectly to fetus 10 has come of age.

While the prior section has discussed the gathering of data and thevalue of this data, the next section shall discuss how that data istransmitted and manipulated in devices located outside of the mother 14.

Antenna

As mentioned earlier, the ECG, temperature and intra-uterine pressureinformation is transmitted from transceiver 42 by the use of a standardradio-telemetry signal 84 to an external monitor or control unit 28.This is accomplished by the radio-telemetry signal 84 being received byan antenna 26. There are three types of antennas 26 which arespecifically contemplated by the invention. The first type of antenna 26is a flexible loop antenna and is illustrated in FIG. 1 as element 26.The second type of antenna is a ring retractor antenna and isillustrated in FIG. 4A as element 26'. The third type of antenna is awand or tubular antenna and is illustrated in FIG. 4B as element 26".The fourth type of antenna is a small contact loop antenna attacheddirectly to the sensing unit 22 and is illustrated in FIG. 4C as element26"'. Each of these antennas 26, 26', 26" and 26"' shall be discussed indetail below.

The flexible loop antenna 26 is formed from a conductive ring or band ofmaterial which is placed around the abdominal wall 18 of the mother 14.In a preferred embodiment, loop 26 will be formed from severalconductive rings or bands which are interwoven. This may be more clearlypictured as several coils of wires which are compressed together. As maybe seen in FIG. 1, a gap G is provided in the last coil of loop 26 toallow for a continuous electrical circuit to be formed between loopantenna 26 and monitor 28. Electrical leads 74 are attached torespective ends of gap G and are provided to allow an electricalconnection between antenna 26 and monitor 28. For clarity only twoelectrical leads 74 have been illustrated in FIGS. 1, 2 and 4A. Itshould be appreciated that the number of electrical leads 74 willcorrespond to the number of monitored characteristics or sensorsutilized in the fetal monitoring system 20. In a multiplexed system,there will only be one electrical lead 74. This ring structure is thepreferred antenna 26 structure for both intra-operative andpostoperative periods since the antenna 26 is capable of receiving asignal from any position within the mother 14, i.e., omnidirectional.Additionally, the antenna 26 may be bent to any shape, due to themallable nature of the conductive rings, and thus may be bent to conformto the shape of the mother's abdomen 18.

The ring retractor antenna 26' which is illustrated in FIG. 4A comprisesa conventional ring retractor such as that disclosed by Gauthier in U.S.Pat. No. 4,010,741. The conventional ring retractor is modified byproviding a gap G in a conductive ring 76 for allowing a continuouselectrical circuit to be formed between ring retractor antenna 26' andmonitor 28. Electrical leads 74 are attached to respective ends of gap Gfor providing an electrical connection between antenna 26' and monitor28. Additionally, there are a plurality of arms 78, each of which issecured to ring 76 and supports an associated retractor 80. The ringretractor antenna 26' functions in a similar fashion to a conventionalring retractor but also provides the ability to receive sensorinformation from transceivers 42 and 64 via radio-telemetry signal 84.This antenna 26' has the advantage of not increasing the number ofadditional devices which are present during an operation and thus, isthe best choice for intra-operative monitoring. For best results,antenna 26' is used in conjunction with antenna 26 to receive anaccurate radio-telemetry signal from transceivers 62 and 64.

In a similar fashion as loop antenna 26, a small contact loop antenna26"' is illustrated in FIG. 4c. This contact antenna 26"' is fastened ina similar manner as loop antenna 26 except it is much smaller in size,i.e, approximately 1-2 cm diameter loop. The contact antenna is designedto be used during an interoperative period and is placed around and incontact with sensing unit 22. The antenna 26"' is attached to a wirelead 74 which is attached to monitor 28.

Finally, a wand or finger antenna 26" may be utilized in particularcircumstances. The finger antenna 26" is a unidirectional antenna andthus is more limited than the flexible loop antenna 26. Antenna 26" isuseful for postoperative monitoring of both fetus 10 and mother 14. In apreferred embodiment, this finer antenna 26" is provided with an RJ-11jack and associated signal processing circuitry at a distal end to allowantenna 26" to be attached to a conventional modem 82. Thus, while amother 14 is at home, her doctor may receive sensor information at aremote site such as a hospital or office. This communication system isdiscussed in greater detail below.

It should be appreciated that a combination of the above antennas may beutilized to provide the best data signal to monitor 28. Additionally,the purpose of antenna 26", illustrated in FIG. 4 may be achieved byusing either antenna 26, 26' or 26"' in place of antenna 26". Finally,it should be appreciated that any known antenna which may receivefrequencies in the frequency ranges of conventional radio-telemetrydevices may be utilized in place of any of the above identifiedantennas.

Monitor

Turning back to FIGS. 1 and 2, a generic monitor 28 is illustrated.Monitor 28 includes a signal input means 86; a receiver 88 forprocessing the signal from input means 86; a computing means 90; andoutput means for visual or printed displays 92 and 94, respectively. Ina preferred embodiment, the signal input means 86 is a patch panel whichutilizes standard banana connectors affixed to electrical leads 74.Signals from input means 86 will be processed by a receiver, modelCTR-86-SA-OPO7 and model BCM-100 consolidated matrix, produced by DataSciences and distributed by Mini-Mitter Co. of Sunriver, Oreg. Earlytrials utilized a CTR-86 which had only electrocardiogram orelectromyogram and temperature outputs. The signal output was an analogECG or ECM and a voltage which corresponded to the temperature. Thecomputing means 90 was Hewlett-Packard Vectra Model 50 which is producedby Hewlett-Packard Co. of Sunnyvale, Calif. The computing means 90further comprises a 10 MHz 80287 math coprocessor produced by IntelCorp. of Hillsboro, Oreg. and a DQ-1088 data acquisition card producedby Data Sciences, Inc. of St. Paul, Minn. Unfortunately this device wasexceedingly clumsy and unreliable.

In a preferred embodiment pressure measurements are also taken. Thetransmitted multiplexed signal, i.e. the ECG, temperature and pressureis received by any of several antennas 26 described above and decoded byone of several receivers produced by Data Sciences, e.g., RIA 3000.Further signal processing and digital to analog conversion is performedby a DL10 decoder with analog (voltage) outputs by A10, All and A12options. These analog signals are then processed by the computing means90, e.g., a Macintosh 950 computer. The computing means 90 is alsoequipped with a National Instruments NB-M10-16 I/O board and a nationalInstruments NB-DMA 2800 interface board.

A computer based data acquisition system software package LabView,Version 2.2.1, is operated within computing means 90 for manipulatingthe data to determine the health of mother 14. This software package hasbeen specifically modified to detect conditions such as fetal distress,hypothermia, and the onset of parturition. The application of thesemodifications are discussed below in conjunction with the overalloperation of the fetal monitor 20.

Output from the computing means 90 may be displayed on a visual displaymeans 92 such as a cathode ray tube (CRT), liquid crystal display or anyother display means known in the art. Additionally, output fromcomputing means 90 may be displayed on a strip chart recorder 94 such asModel MT 9500-OR produced by Coulbourn Instruments of Lehigh Valley, Pa.This strip chart recorder 94 allows for the simultaneous real timedisplay of fetal temperature and recording of analog fetalelectrocardiogram on a strip chart 96.

Additionally, a continuous real time display 92 of the electrocardiogramsignal may be displayed on a Lifepak Six produced by Physio-Control, ofRedmond, Wash.

Uterine Monitor

Referring to FIG. 5, an optional uterine monitor 88 is illustrated inconjunction with the fetal monitor 20. Uterine monitor 88 providesinformation such as intra-uterine pressure, uterine temperature, andmaternal uterine electromyogram to monitor 28. For a complete discussionof the uterine monitor 88, please see U.S. Application Ser. No.08/081,133 which is hereby incorporated by reference.

Operation of Device

Turning now to the operation of the fetal monitor 20 in conjunction withthe uterine monitor 88, reference is made to FIGS. 6A, 6B, 7, 8, 9, and10A-10D. As stated earlier, fetal monitor 20 is designed for use duringintra-operative and postoperative periods as well as during the onset ofparturition.

During the intra-operative and postoperative periods, the fetal monitor20 will monitor a fetal electrocardiogram signal 90 as illustrated inFIG. 6B. as well as a fetal heart rate, generally denoted 92 in FIG. 7.The electrocardiogram signal 90 is first detected by electrocardiogramleads 32. These leads 32 relay signal 90 to electrocardiogram sensor 34which in turn provides signal processing such as noise reduction andamplification to signal 90 as described above. Signal 90 is thentransmitted by transceiver 42 to antenna 26 or transceiver 64 asdescribed above. Once signal 90 is received by antenna 26, signal 90 isthen transmitted to monitor 28 via electrical leads 74. Based upon theelectrocardiogram signal 90, i.e, the period between consecutive beats,the fetal heart rate variability may be determined as illustrated inFIG. 7.

The fetal heart rate variability is an indicator of fetal distress. Asmay be seen from FIG. 7, heart rate variability has both long term andshort term characteristics. The long term characteristics arerepresented by the envelope D of heart rate 92 and the short termcharacteristics being shown by the ripple R about the envelope E.Envelope E represents a straight line approximation of the actual heartrate 92. In a preferred embodiment, fetal distress is determined fromthe weighted average of the peak to peak distance D in the instantaneousheart rate 92, i.e. long term variability in heart rate. Alternatively,distress may be determined by the variability in short term heart rateas indicated by the distance D'. Finally, distress may be determined ifpredetermined minimum peak to peak limits L are not exceeded within agiven period of time. It should be appreciated that a combination of theabove methods may be employed. Since the fetal heart rate is affected byoutside forces, such as contractions or fetal movement, the heart rateby itself is not a completely reliable indication of fetal distress.Thus, fetal temperature is also measured in a similar fashion to thatdescribed for the electrocardiogram.

This temperature data is vital for determining the onset of hypothermiaand for providing collaborative evidence of fetal distress. Fetaltemperature will vary with time between upper and lower acceptabletemperature limits. By measuring the temperature and determining whenthe temperature falls below preset limits, hypothermia may be determinedquickly and automatically. Additionally, by seeing if there is atemperature variation in conjunction with a heart rate variation, fetaldistress may be accurately determined.

Turning now to monitoring the fetus during parturition, the measurementof fetal temperature and electrocardiogram as well as maternaltemperature, intra-uterine pressure and electromyogram provide anaccurate indication of the onset and progress of parturition and fetalhealth during this time.

During the onset of parturition, the uterine monitor 20 will monitor amaternal electromyogram signal 91 as illustrated in FIGS. 10A through10D and may monitor maternal heart rate. During parturition, muscles inthe uterine wall generate ion fluxes during cell depolarization which inturn lead to cellular contractions. This may be detected as changes involtage across a portion of the muscle and is generally called anelectromyogram. The voltage detected corresponds to a muscularcontraction. The electromyogram signal 91 is first detected and utilizedin a similar fasion as the fetal electrocardiogram signal 90. It shouldbe appreciated that maternal electrocardiogram ECG and heart rate may bemeasured by standard skin ECG leads but the uterine electromyogramsignal 91 may not.

Once signal 91 is received by antenna 26, signal 91 is then transmittedto monitor 28 via electrical leads 4. This electromyogram signal 91provides an accurate indication of the beginning and end of acontraction. This information is essential for accurately determiningthe onset of parturition.

The generally accepted way to determine the progress of parturition isto time the interval between contractions. This method, while indicativeof the general onset of parturition, is highly inaccurate fordetermining the exact progress of parturition and may be totallyinaccurate due to false labor pains. Since the onset of labor pains arebrought on by contractions, the measurement of contraction intervals isonly one information source. The intensity of the contractions isanother vital source of information in the determination of parturition.In the past, this intensity information was provided as a qualitativemeasurement by the mother to the health care professional. Thus theprior art does not disclose a quantitative method for measuring theintensity of uterine contractions as described above nor does itdisclose an accurate method of determining the beginning or end of acontraction.

While this electromyogram information is indicative of parturition,false alarms may be generated. Therefore intra-uterine pressure is alsoutilized in the determination of parturition.

In a preferred embodiment of the invention, intra-uterine pressure ismeasured by a pressure transducer as described above. This informationis then transmitted to monitor 28 in a fashion similar to that of theelectromyogram signal 91. As may be seen in FIGS. 8 and 10A though 10D,curves of intra-uterine pressure 94 are illustrated. There are severalcharacteristics which may be determined from the intra-uterine pressure.The duration or period P of a contraction may be determined by thefluctuation in intra-uterine pressure over a time period T. The timebetween contractions, indicated as C, may also be measured. Finally, theintensity of contractions I may be determined. Based upon any one ofthese or preferably a combination of the above, the onset and progressof parturition may be determined. In a preferred embodiment, theintegral of the intra-uterine pressure taken over ten minute intervalsis utilized to generate a contractibility index, generally denoted 96 inFIG. 9. The contractibility index 96 allows for the graphicalrepresentation of the progress of parturition. A medical professionalmay determine whether the contractions are indicative of a false laboror are actually the onset of parturition. As may be seen in FIG. 9, thecontractility index may be broken up into four discrete regions, severelabor, moderate labor, mild labor and no labor. A medical professionalmay determine how far along the patient is by the magnitude of the lastcontractibility index reading. This is vitally important for determiningif and when to perform a caesarean section, or for the administration ofmedication. In a preferred embodiment, a ten minute time period isutilized for determining the index values but it should be appreciatedthat any time interval may be utilized.

Additionally, fluctuations in intra-uterine pressure may be used toprovide corrections to both the fetal electrocardiogram and maternaluterine electromyogram signals. The maternal electrocardiogram signal isillustrated in FIG. 6A as curve 93. These electromyogram andelectrocardiogram signals are utilized to determine the health of bothfetus 10 and mother 14 and the onset of parturition.

As may be seen form FIGS. 10A through 10D, there is a close correlationbetween increasing intra-uterine pressure and increases inelectromyogram. This collaborates the theory that the myometriumcontractions are causing the increase in intra-uterine pressure asopposed to application of an external force such as a situp, a handpushing on the abdomen or possibly even gastric digestion. Thus, bycorrelating the intra-uterine pressure information with that of theelectromyogram, false indications of labor are reduced.

Turning now to the use of the temperature information, maternal or fetaltemperature also may be measured in a similar fashion to that describedfor the electromyogram signal 91 and electrocardiogram signal 90. Asindicated above, there is a correlation between a drop in temperature offetus 10 and mother 14 and the onset of parturition. While the prior arthas suggested this correlation, it has failed to provide an accurate wayof determining uterine or fetal temperature. But temperature alone isnot a good indicator of the onset of parturition. The combination oftemperature, intra-uterine pressure and electromyogram data provide themost accurate indication of the onset of parturition. This is becausethere must be a temperature drop in conjunction with elevatedintra-uterine pressure and electromyogram response. It should beappreciated that the prior art neither teaches or suggests themonitoring of these three characteristics for determining parturition.Additionally, the invention contemplates the concept of monitoringmaternal hear rate variability for monitoring maternal health.

These signals in combination with the temperature, pressure andelectromyogram signals may be utilized to automatically administer drugsfrom medication dispenser 24 for aiding or slowing the parturitionprocess as described above. FIG. 10A through 10D illustrate theprogressive effect of injecting a mother with labor inhibiting drugs ofincreasing dosages. As may be seen in FIG. 10A the patient is in severelabor with impending delivery. By injecting the patent with a laborinhibiting drug, the doctor may slow the labor process to a moderatelevel or mild level as illustrated in FIGS. 10B and 10C, respectively.The Doctor may even stop the labor process as indicated in FIG. 10D. Thecombination of intra-uterine pressure and electromyogram data provide anaccurate indication of the onset of parturition. It should beappreciated that the prior art neither teaches or suggests themonitoring of both intra-uterine pressure and electromyogram data forthe determination of parturition.

Finally, it should be appreciated that the prior art neither teaches orsuggests the monitoring of fetus 10 for the determination ofparturition. All prior art device focus on the mother and thus ignoresthe second most important participant in the birthing process.

Alternative Monitoring

This system may allow monitoring of fetus 10 while mother 14 is awayfrom the hospital. This is accomplished by interfacing a standard ECGmonitor 28 to a modem 98 at the medical facility and having acorresponding remote unit at the mother's remote location. The remoteunit comprises a second modem 82 corresponding to the medical facilitymodem 98; a transceiver 100 for transmitting and receiving informationto modem 82, an antenna 26" for receiving information from fetal monitor20. In a preferred embodiment, transceiver 100 and antenna 26" aremaintained in a wand shaped housing 102. Optional signal processingcircuitry for providing compatibility between the remote sensing unitoutput signals and the ECG input signals may be provided. By using theradio-telemetry device described above and a conventional ECG 28, thesignal processing circuity may be eliminated.

In operation, the radio-telemetry signal 84 is received by antenna 26"as described above. Then this signal is processed by conventional signalprocessing circuity to generate a signal compatible with modem 82.Modems 82 and 98 are conventional in nature and allow communicationacross a network 104. It should be appreciated that network 104 may be apacket switched network, a conventional telephone line, a T1 network orany other communications network functioning with or without encryption.Once the signal is received by modem 98, it is converted to a formatcompatible with monitor 28 which functions substantially as describedabove.

Medical Trials

Five trials have been performed during congenital diaphragmatic herniarepairs on human fetuses 10. The fetal electrocardiogram and temperaturewere recorded accurately, and demonstrated that the system 20 functionedin the electrically noisy operating room environment. Of note from thesetests was the failure of other intra-operative fetal monitoringtechniques. The skin electrodes failed to detect fetalelectrocardiograms and the fetal pulse oximeter failed altogether in onecase.

Postoperatively, adequate close monitoring of fetal electrocardiogramand temperature was maintained with the radio-telemetry monitoringdevice 20, described above, for over four weeks. Finally there were nocomplications associated with the radio-telemetry monitoring device 20.

Although the present invention has been fully described in connectionwith the preferred embodiment thereof with reference to the accompanyingdrawings, it is to be noted that various changes and modifications areapparent to those skilled in the art. Such changes and modifications areto be understood as included within the scope of the present inventionas defined by the appended claims, unless they depart therefrom.

What is claimed is:
 1. A fetal monitor and system for measuringcharacteristics indicative of fetal health, and taking action based uponthe health of the fetus is provided, said monitor comprising:means forsensing a temperature of a fetus and for outputting a fetal temperaturesignal; means for sensing an electrocardiogram of said fetus and foroutputting a fetal electrocardiogram signal; and means for receivingsaid fetal temperature and electrocardiogram signals and for determiningthe existence of fetal conditions based upon said fetal temperature andelectrocardiogram signals.
 2. The fetal monitor recited in claim 1,wherein said means for sensing said electrocardiogram of said fetuscomprises:at least one electrocardiogram lead having an exposed distalend, said electrocardiogram lead for receiving electrical signalsindicative of a fetal electrocardiogram; a noise reduction means securedto a proximal end of said electrocardiogram lead; and an amplificationmeans for amplifying said electrocardiogram signal.
 3. The fetal monitorrecited in claim 2, wherein said electrocardiogram lead is adapted to bemaintained subcutaneously within said fetus for preventing accidentalshort circuits.
 4. The fetal monitor recited in claim 1, wherein saidoutputting means for said fetal electrocardiogram signal comprises atransceiver.
 5. The fetal monitor recited in claim 4, wherein saidtransceiver is a radio-telemetry transceiver.
 6. The fetal monitorrecited in claim 1, wherein said means for sensing said temperature ofsaid fetus comprises a temperature sensor which is adapted to bedisposed on and in contact with said fetus.
 7. The fetal monitor recitedin claim 1, wherein said outputting means for said fetal temperaturecomprises a transceiver.
 8. The fetal monitor recited in claim 7,wherein said transceiver is a radio-telemetry transceiver.
 9. The fetalmonitor recited in claim 1, wherein said means for receiving comprisesan antenna.
 10. The fetal monitor recited in claim 9, wherein saidantenna is a ring retractor antenna.
 11. The fetal monitor recited inclaim 9, wherein said antenna is a flexible loop of conductive material.12. The fetal monitor recited in claim 9, wherein said antenna is afinger antenna.
 13. The fetal monitor recited in claim 1, wherein saiddetermining means comprises:a receiver for receiving said fetalelectrocardiogram and temperature signals; a computing means; and anoutput means.
 14. The fetal monitor recited in claim 13, wherein saidcomputing means comprises a central processor, memory, arithmetic logicunit, and a communications bus for passing said fetal electrocardiogramand temperature signals from said receiver to said output means.
 15. Thefetal monitor recited in claim 13, wherein said output means comprises aliquid crystal display.
 16. The fetal monitor recited in claim 13,wherein said output means comprises a cathode ray tube.
 17. The fetalmonitor recited in claim 13, wherein said output means comprises a stripchart recorder.
 18. The fetal monitor as recited in claim 1, furthercomprising a means for continually sampling intra-uterine pressure andfor outputting a sampled intra-uterine pressure signal.
 19. The fetalmonitor recited in claim 18, wherein said means for continually samplingintra-uterine pressure comprises:a pressure transducer; and a pressuretransmission catheter for providing fluid communication between amnioticfluid contained in a uterus and said pressure transducer.
 20. The fetalmonitor recited in claim 18, wherein said means for sensingintra-uterine pressure comprises a solid state pressure transducer. 21.The fetal monitor recited in claim 1, further comprising an automaticdispensing means for dispensing medication to said fetus upon theexistence of a particular fetal condition.
 22. The fetal monitor recitedin claim 21, wherein said automatic dispensing meanscomprises:communications means for communicating with said determiningmeans; a pump for dispensing said medication; a reservoir formaintaining said medication for said pump; and actuation means forreceiving a signal from said communications means and for actuating saidpump based upon said signal.
 23. The fetal monitor recited in claim 22,wherein said communications means comprises a transceiver.
 24. The fetalmonitor recited in claim 23, wherein said transceiver is aradio-telemetry transceiver.
 25. The fetal monitor recited in claim 22,wherein said pump is a piezoelectrically driven micro-pump.
 26. Thefetal monitor recited in claim 22, wherein said reservoir is acollapsible bag.
 27. The fetal monitor recited in claim 21, wherein saidautomatic dispensing means comprises:communications means forcommunicating with said outputting means for said fetalelectrocardiogram signal and for communicating with said outputtingmeans for said fetal temperature signal; a pump for dispensing saidmedication; a reservoir for maintaining said medication for said pump;and actuation means for receiving said fetal electrocardiogram andtemperature signals from said communications means and actuating saidpump based upon said signals.
 28. The fetal monitor recited in claim 1,further comprising an automatic means for dispensing medication to amother of said fetus upon the existence of a particular fetal condition.29. The fetal monitor recited in claim 28, wherein said automaticdispensing means comprises:communications means for communicating withsaid determining means; a pump for dispensing said medication to saidmother; a reservoir for maintaing said medication for said pump; andactuation means for receiving a signal from said communications meansand for actuating said pump based upon said signal.
 30. The fetalmonitor recited in claim 29 wherein said communications means comprisesa transceiver.
 31. The fetal monitor recited in claim 30 wherein saidtransceiver is a radio-telemetry transceiver.
 32. The fetal monitorrecited in claim 29, wherein said pump is a piezoelectrically drivenmicro-pump.
 33. The fetal monitor recited in claim 29, wherein saidreservoir is a collapsible bag.
 34. The fetal monitor recited in claim 1further comprising a uterine monitor, said uterine monitorcomprising:means for sensing temperature of a mother and for outputtinga sampled maternal temperature signal, means for sensing electricalactivity of a uterine muscle of a mother and for outputting a sampledmaternal electromyogram signal, and means for receiving said maternaltemperature and electromyogram signals and for determining the existenceof fetal conditions based upon said sampled maternal temperature,maternal electromyogram, fetal temperature, and fetal electrocardiogram.35. The fetal monitor recited in claim 34, wherein said means forsensing said electromyogram of said mother comprises:at least oneelectromyogram lead having an exposed distal end, said electromyogramlead for receiving electrical signals indicative of a maternal uterineelectromyogram; a noise reduction means secured to a proximal end ofsaid electromyogram lead; and an amplification means for amplifying saidelectromyogram signal.
 36. The fetal monitor recited in claim 35,wherein said electromyogram lead is adapted to be maintainedsubcutaneously within a uterine wall of said mother for preventingaccidental short circuits.
 37. The fetal monitor recited in claim 34,wherein said means for sensing temperature of said mother comprises atemperature sensor which is adapted to be disposed on and in contactwith a uterine wall of said mother.
 38. The fetal monitor recited inclaim 34, wherein said outputting means for said maternal electromyogramsignal comprises a transceiver.
 39. The fetal monitor recited in claim38, wherein said transceiver is a radio-telemetry transceiver.
 40. Thefetal monitor recited in claim 34, wherein said sampled maternaltemperature, maternal electromyogram, fetal temperature, and fetalelectrocardiogram signals are outputted at different frequencies, onefrequency for each sampled signal.
 41. The fetal monitor recited inclaim 34, wherein said outputting means for said maternal temperaturesignal comprises a transceiver.
 42. The fetal monitor recited in claim41, wherein said transceiver is a radio-telemetry transceiver.
 43. Thefetal monitor as recited in claim 34, further comprising a means forsensing intra-uterine pressure and for outputting a sampledintra-uterine pressure signal.
 44. The fetal monitor recited in claim43, wherein said means for sensing intra-uterine pressure comprises:apressure transducer; and a pressure transmission catheter for providingfluid communication between amniotic fluid contained in a uterus andsaid pressure transducer.
 45. The fetal monitor recited in claim 43,further comprising a means for receiving said intra-uterine pressuresignals and for determining the onset of parturition based upon saidsensed maternal temperature, maternal electromyogram, intra-uterinepressure, fetal temperature, and fetal electrocardiogram.
 46. The fetalmonitor recited in claim 43, wherein said means for sensingintra-uterine pressure comprises a solid state pressure transducer. 47.A fetal monitoring system for measuring characteristics indicative offetal health, said monitoring system comprising:a remote sensing unit,said remote sensing unit containing means for sensing temperature of afetus and for sensing an electrocardiogram of said fetus, said remotesensing unit also housing a transceiver for outputting sampled fetaltemperature and electrocardiogram signals, said remote sensing unitmaintained within close proximity of said fetus for allowing said fetaltemperature to be sampled; an antenna for receiving said sampled fetaltemperature and electrocardiogram signals from said transceiver; and amonitoring station for monitoring said fetal temperature andelectrocardiogram signals, said monitoring station comprising a receiverfor receiving said fetal electrocardiogram and temperature signals fromsaid antenna, a computing means for manipulating said fetalelectrocardiogram and temperature signals, and an output means fordisplaying information from said fetal electrocardiogram and temperaturesignals.
 48. The fetal monitor as recited in claim 47, furthercomprising a means for continually sampling intra-uterine pressure andfor outputting a sampled intra-uterine pressure signal.
 49. The fetalmonitor recited in claim 48, wherein said means for continually samplingintra-uterine pressure comprises:a pressure transducer; and a pressuretransmission catheter for providing fluid communication between amnioticfluid contained in a uterus and said pressure transducer.
 50. The fetalmonitor recited in claim 47, wherein said computing means comprises acentral processor, memory, arithmetic logic unit, and a communicationsbus for passing said fetal electrocardiogram and temperature signalsfrom said receiver to said output means.
 51. The fetal monitor recitedin claim 47, wherein said output means comprises a liquid crystaldisplay.
 52. The fetal monitor recited in claim 47, wherein said outputmeans comprises a cathode ray tube.
 53. The fetal monitor recited inclaim 47, wherein said output means comprises a strip chart recorder.54. A fetal monitoring system for measuring characteristics indicativeof fetal health, said fetal monitoring system comprising:a fetalmonitor, said fetal monitor comprising a means for sensing temperatureof a fetus and for outputting a fetal temperature signal, a means forsensing an electrocardiogram of said fetus and for outputting a fetalelectrocardiogram signal; an antenna for receiving said fetaltemperature and electrocardiogram signals from said outputting means; acommunications network for allowing the communication of said fetalelectrocardiogram and temperature signal to a remote site; a means forconverting said fetal temperature and electrocardiogram signals fromsaid antenna to be compatible with said communications network; amonitoring station for remotely monitoring said fetal temperature andelectrocardiogram signals, said monitoring station comprising a receiverfor receiving said fetal electrocardiogram and temperature signals, acomputing means for manipulating said fetal electrocardiogram andtemperature signals, and an output means for displaying information fromsaid fetal electrocardiogram and temperature signals; and a means forconverting said fetal temperature and electrocardiogram signals fromsaid communications network to be compatible with said monitoringstation.
 55. The fetal monitor as recited in claim 54, furthercomprising a means for sensing intra-uterine pressure and for outputtingan intra-uterine pressure signal.
 56. The fetal monitor recited in claim55, wherein said means for sensing intra-uterine pressure comprises:apressure transducer; and a pressure transmission catheter for providingfluid communication between amniotic fluid contained in a uterus andsaid pressure transducer.
 57. The fetal monitor recited in claim 55,wherein said means for sensing intra-uterine pressure comprises a solidstate pressure transducer.